Juvenile ewing sarcoma presenting as a pelvic mass

A teen aged girl with rapidly developing pelvic mass, associated with weight loss and left leg weakness, was evaluated and found to have Ewing\u27s sarcoma of non-osseous origin from pelvis, which is a rare situation. She was treated by a multidisciplinary approach by surgery, chemotherapy and rehabilitation by physiotherapy to effective response

Frequency of endometriosis among infertile women and association of clinical signs and symptoms with the laparoscopic staging of endometriosis

OBJECTIVE: The study aimed to determine the frequency of endometriosis in women who underwent diagnostic laparoscopy for evaluation of infertility and the association of clinical, ultrasonographic and laparoscopic findings of endometriosis with the laparoscopic stages of the disease.METHOD: It was a retrospective study of women presenting to gynaecologic clinics of the Aga Khan University Hospital from January 1999 to December 2005 with primary complaint of primary or secondary infertility and were diagnosed with endometriosis through laparoscopy. Relevant demographic and clinical information was entered and analyzed in SPSS version 14.0.RESULTS: The frequency of endometriosis in women with primary compliant of infertility was found to be 16.8%. Statistically significant associations was found between staging of the disease and thin built (p=0.007) and restricted uterine mobility on pelvic examination (p=0.035). The patients\u27 ultrasound and laparoscopic examination showed significant association with staging of the disease with the presence of cysts on ultrasound (p-value \u3c 0.0001) and adhesions on laparoscopy (p valu

Continuation of Metformin Reduces Early Pregnancy Loss in Obese Pakistani Women with Polycystic Ovarian Syndrome

Background: Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility worldwide. In addition to a poor conception rate, pregnancy loss rates are significantly higher (30-50%) during the first trimester in women with PCOS. Insulin resistance (IR) in this syndrome is not only implicated toward early pregnancy loss (EPL) but also pathognomic for various obstetrical complications during pregnancy. We evaluated the role of Metformin in the reduction of EPL in women with PCOS who conceived spontaneously or after induction ovulation with or without Metformin. Objective: The primary objective was to evaluate the effectiveness of Metformin in the reduction of EPL in women with PCOS. Secondary outcomes like gestational diabetes, pregnancy-induced hypertension and intrauterine growth restriction were also analyzed at the end of the study. Material and Methods: This case-control study was conducted from March 2005 to March 2008 in the infertility and antenatal clinics of the Department of Obstetrics and Gynecology of Aga Khan University Hospital, Karachi, Pakistan. A total of 197 infertile women with PCOS were included. \u27Cases\u27 were women with PCOS who conceived while taking Metformin and it whom it was continued throughout pregnancy. \u27Controls\u27 were women in whom Metformin was either stopped in first trimester after confirmation of pregnancy (by serum beta HCG or by ultrasound) or they conceived spontaneously without the use of Metformin. Results: All 197 women in this study had a confirmed diagnosis of PCOS (Rotterdam criteria). These women were followed till the final outcome of pregnancy was achieved. Both groups were compared for risk of EPL. It was found that continuation of Metformin during pregnancy reduces EPL, i.e. 8.8 vs. 29.4% in cases and controls, respectively (p \u3c 0.001). In the subset of women with a prior history of miscarriage, the pregnancy loss rate was 12.5% in the Metformin versus 49.4% in control group (p = 0.002). Conclusion: Metformin continuation during pregnancy significantly reduces EPL in women with PCOS. IR may play a significant role in EPL

Urinary tract injuries during obstetrics and gynaecological surgical procedures at the Aga Khan University Hospital Karachi, Pakistan: A 20-year review

Objective: To determine the prevalence of urinary tract injuries, identification of risk factors and methods employed for repair and their outcomes.Study Design: Cross-sectional study of patients who had urinary tract injuries during major obstetric and gynaecological surgeries at the Aga Khan University Hospital (AKUH) from 1985 to 2004.Material and Methods: Computer-generated discharge summaries of patients who underwent major obstetric and gynaecological procedures during the 20 years of study period were retrieved. Information was collected on data collection form, and entered in SPSS version 13 and analysed.Results: During the study period 12,567 obstetrics and 5,966 gynaecological procedures were performed. There were 3,910 abdominal hysterectomies, 984 myomectomies, 591 ovarian/adenexal surgeries and 481 vaginal hysterectomies. Out of these 110 urinary tract injuries were identified, 71 (64.5%) were of the urinary bladder and 39 (35.5%) were ureteric in origin, 31 (43.6%) bladder injuries were sustained during caesarean sections while 40 (56.3%) were during gynaecological procedures. In obstetric cases there were two ureteric injuries, the other ureteric injuries were sustained during surgeries for benign gynaecological conditions. The prevalence of bladder and ureteric injuries in obstetric surgeries was 0.25 and 0.02%, respectively, whereas in gynaecological surgeries the prevalence was 0.7 and 0.6% for urinary bladder and ureteric injuries. These figures compare well with other published series.Conclusion: Urinary tract injuries are an uncommon occurrence but when they occur they have serious implications in terms of morbidity and litigation. The prevalence of urinary bladder and ureteric injuries observed in our review is comparable to previous reported international series. Of concern is the fact that most of the ureteric injuries were diagnosed post operatively which means that further vigilance and preventive strategies need to be designed

Prevalence of low back pain experienced after delivery with and without epidural analgesia: A non-randomised prospective direct and telephonic survey

Background and Aims: The most frequent concern of patients receiving epidural analgesia for labour pain relief is post-partum back pain. This survey was designed to assess the prevalence of post-partum backache with and without epidural analgesia among post-partum women.Methods: The study was conducted at a university teaching hospital and women presenting to labour room for labour and delivery formed the target population. A total of 482 women were recruited during the study period. Response rate was 95.4% and these cases were included in our statistical analysis. Two forms were designed for data collection before and after delivery; form I was filled by one of the investigators while form II was filled by a research assistant to prevent bias which included follow-up of back pain. The primary outcome variable was backache quantified with visual analogue scale score. Out of 460 women, 230 women received epidural analgesia for labour and 230 women had not.Results: The prevalence of post-partum back pain in epidural analgesia versus non epidural analgesia groups was 40.9% versus 40% on day one and 32.2% versus 35.2% after 1 week. However, after one and 3(rd) months follow-up, backache prevalence was less in epidural analgesia group (unadjusted odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.39-0.99) and (unadjustedd OR: 0.32; 95% CI: 0.15-0.69) respectively. The adjusted odd ratio was 0.59 at 1st month and 0.25 at 3rd month. There was no significant difference between the two groups in pain scores.CONCLUSION: There was no association between the epidural analgesia and post-partum back pain

Prevalence of abnormal Papanicolaou smears and cytohistological correlation: A study from Aga Khan University Hospital, Pakistan

Objectives: To determine the prevalence of abnormal Papanicolaou (Pap) smears in patients visiting the gynecologic outpatient department at Aga Khan University Hospital, Karachi (AKUH) and their cytohistologic correlation. This data was also compared with other international institutions. Methods: A database search of all abnormal cervical cytological cases diagnosed in the gynecologic outpatient department at Aga Khan University Hospital in the last 10 years (i.e. from 1994 to 2004), as well as their follow-up biopsies, was carried out. The data was then analyzed. Results: Of the 66 617 Pap smears reviewed, 95% of cases had a diagnosis of ‘negative’, 2% of smears were labeled as ‘inadequate’, 0.54% Pap smears showed dysplastic changes, and 0.14% were labeled as ‘malignant’. These numbers are less than figures in Western countires, but are comparable with Asian figures. The pick-up rate for abnormal Pap smears was 8/1000, while the overall concordance rate was 74%; positive predictive values for high-grade cervical lesions and for carcinomas was high 92–100%, respectively; while for ASCUS and low-grade cervical lesion was 35% and 67%, respectively. A total number of 8 cases were identified where there was a discrepancy between cytological and histological diagnosis, they were reviewed critically. Conclusion: In most of the developing countries effective Pap screening faces certain barriers. This includes limited or poor quality of cytology services. In a low-resource country like Pakistan there is a subset of patients (those with atypical cellular abnormalities) who may benefit from repeat smears instead of early cervical biopsies. In order to improve the efficacy of our cytology services, we need to develop specific clinical protocols for subsequent management of abnormal smears